Ultrasound-Guided Vacuum-Assisted Breast Biopsy for Breast Intraductal Lesions: a Meta-Analysis of Underestimation and Pathological Nipple Discharge Cure Rates

Abstract

Background: Breast intraductal lesions present a diagnostic challenge due to the diverse spectrum of histologic changes. Vacuum-assisted biopsy (VAB) has evolved as a pivotal diagnostic and therapeutic modality. Yet, concerns about the underestimation of malignancy using VAB persist. This review examines the underestimation rates of Ultrasound-guided VAB (US-VAB) for intraductal lesions and evaluates the effectiveness of VAB in addressing pathological nipple discharge (PND). Methods: Following PRISMA guidelines, a comprehensive search was performed across Scopus, PubMed, and Web of Science. Studies detailing the underestimation rates of intraductal breast lesions diagnosed by US-VAB and cure rates for PND post-VAB excision were selected. Statistical analysis comprised a random effects proportion meta-analysis. Results: In this research, 31 studies were deemed eligible: 26 for underestimation and 5 for PND cure rates post-US-VAB. Quantitative synthesis focused on studies reporting data on atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) due to limited availability for other pathologies. The pooled underestimation rate for ADH was 6.14% (95% CI: 1.59%-12.43%). The pooled underestimation rate for DCIS was 13.26% (95% CI: 6.69%-21.08%). PND's pooled cure rate post-US-VAB was 93.32% (95% CI: 82.34%-99.70%). Conclusion: This systematic review and meta-analysis show that US-VAB delivers low ADH underestimation rates, moderate DCIS underestimation rates, and acceptable PND cure rates in breast intraductal lesions.